Positron Emission

Tomography (PET)
Tutorial
Pembimbing : dr. Aulia Huda, Sp.KN.

Gading Pluit Hospital

Department of Radiology
School of Medicine Atma Jaya Catholic University of Indonesia
Jakarta 2016

Oleh :
Jessy Claudia
Swastiko Wiweka Adi
Jesica Tatang
Vincentius Henry Sundah

2014 061 061

2014 061 063
2015 061 019
2015 061 023

Introduksi

Introduksi (1)
Positron Emission Tomography (PET) prosedur pencitraan yang
istimewa.
Mampu mengevaluasi beberapa patofisiologi :

Gangguan neurodegeneratif
Infeksi
Kejang dan epilepsi
Kelainan psikiatri
Tumor otak

Introduksi (2)
PET biasa digunakan sebagai alat pencitraan fungsional / molekular
yang dapat mempelajari fungsi biologis, baik untuk kesehatan dan
penyakit.
MRI & CT perubahan morfologi tubuh.

Introduksi (3)
1976 (Sokoloff et al) menemukan 18F-fluorodeoxyglucose (FDG)
mempelajari metabolisme glukosa pada otak
Neurology
Cardiology
Oncology

Dapat mendeteksi plak -amyloid / plak neuritik pada pasien

Alzheimers.
FDG membedakan bentuk dementia lain : Creutzfeldt Jakob
disease, degenerasi corticobasal, dan dementia ischemic vascular.

Introduksi (4)
PET/CT gambaran fisiologis PET + gambaran morfologis yang detail
CT.
PET/MRI gambaran fisiologis PET + gambaran jaringan lunak yang
baik dari MRI

Instrumen (1)

Instrumen (2)
Proses yang terjadi pada pencitraan PET yang dapat menurunkan
kontras / kualitas gambar :
Randoms
Scatter

Koreksi yang dapat dilakukan :

Koreksi dead time
Koreksi attenuation

Typical multimodality positron

emission tomography
(PET)/computed tomography
(CT) imaging system combining
a state-of-the-art PET scanner,
for molecular imaging, with a
multiple-detector-row CT
scanner, for anatomic imaging.
The software and hardware are
optimized to acquire
complementary information
from a patient bed moving
through both scanners. For the
CT component of the scan,
lasting seconds, the table moves
uninterrupted while a
continuous volume is acquired
in spiral scan mode. For PET
images, the bed moves in
incremental steps based on the
PET detectors field-of-view
(typically 16.2 cm) with each
acquisition typically taking 36
minutes. The PET detector ring
is shown with a multicrystal
scintillation detector and
photomultiplier tubes. The
electronics and detector localize
annihilation-photon absorption
to a single crystal. FDG, 18Ffluorodeoxyglucose.

 Isotope production
Tracer production
Imaging

CYCLOTRONS
CHEMISTRY SYSTEMS
SCANNER

Positron Emitting Isotopes

Isotope

Half-Life

Production

Carbon-11

20.5 min

14N(p,)11C

Nitrogen-13

10.0 min

16O(p,)13N

Oxygen-15

2.1 min

14N(d,n)15O

Fluorine-18

110 min

18O(p,n)18F

(F-)

20Ne(d,)18F

Gallium-68

68 min

Rubidium-82 1.27 min

(F2)

Daughter of Ge-68 (271days)

Daughter of Sr-82 (25days)

Small elements (C,N,O,F) allow real biochemistry

Short half-lives make tracer production an integral part of PET

Tracer ex: 18F FDG ( 18F labeled fluorodeoxyglucose )

Interpretasi PET Scan (1)

Area pada otak yang metabolismenya paling aktif :

Cortical gray matter

Primary visual cortex
Motor cortex
Subcortical gray matter of basal ganglia dan thalamus

Cerebellum aktivitasnya lebih rendah dibandingkan struktur

kortikal seupratentorial

Interpretasi PET Scan (2)

Seiring bertambahnya usia, terjadi dilatasi yang progresif dari sulkus
dan fisura disertai dengan penurunan aktivitas metabolik pada
substansia alba dan grisea.
CT dan MRI dapat mendeskriminasi area yang aktivitas 18F-FDG
menurun karena kelainan anatomi (sepeti encephalomalacia atau
atrofi parah).

Transaxial 18F-fluorodeoxyglucose positron emission tomography

images of a normal brain with attenuation correction (left image) and
without attenuation correction (right image).

(A) Normal adult 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) images in sagittal (left) and
coronal (right) planes. FDG activity in the cerebellum is slightly less than the FDG activity in cerebral cortex.
(B) FDG PET images from an adult with cerebral atrophy in sagittal (left) and coronal (right) planes. FDG activity in
the cerebellum is very similar to the FDG activity in cerebral cortex. Note the widened sulci and enlarged lateral
ventricles from the patients cerebral atrophy.
(C) Normal FDG PET images from a 6-year-old girl in sagittal (left) and coronal (right) planes. FDG activity in the
cerebellum is significantly decreased compared to cerebral cortex.

Interpretasi PET Scan (3)

Untuk mengukur 18F-FDG, dapat dilakukan dengan melakukan
perhitungan standardized uptake value (SUV) populer untuk
mengukur staging tumor dan respon tumor terhadap terapi.
Definisi SUV :
konsentrasi 18F-FDG (mCi/mL)
dosis 18F-FDG yang diinjeksi (mCi)
berat pasien (gram)

Radiofarmaka

Radiofarmaka
Senyawa radioaktif yang diberikan kepada pasien dan di
monitor dengan pencitraan spesik untuk keperluan diagnosis
dan terapeutik

Hacker M. PET & SPECT Oncology. Available from: http://www.whatisnuclearmedicine.com/Whatis-69PET%20&%20SPECT%20-%20Oncology

Jenis-jenis Radiofarmaka

Moghbel M, Newberg A, Alavi A. Positron emission tomography: ligand imaging.

Philadelphia: Elsevier; 2016.

Radiofarmaka
18F-Fluorodeoxyglucose analog glukosa
mengalami metabolisme glukosa

METABOLISME GLUKOSA

Metabolisme Glukosa

1.GLIKOLISIS

Metabolisme Glukosa

2. SIKLUS
KREBS

Metabolisme Glukosa
3. BETA OXIDATION

18F-fluorodeoxyglucose

(FDG)

FDG adalah analog glukosa yang mengalami

metabolisme yang sama dengan glukosa
FDG difosforilasi menjadi FDG-6-phosphate
tidak dapat mengalami glikolisis terperangkap
intraseluler akumulasi FDG di dalam sel
tumor

Herring W.. Learning Radiology Recognizing The Basics 3 rd Edition. Elsevier. 2016
Zhu A., Lee D., Shim H.. Metabolic PET Imaging in Cancer Detection and Therapy Response.
Semin Oncol. 2011

18F-fluorodeoxyglucose

(FDG)

Tumor ganas mengalami peningkatan

metabolisme glukosa (peningkatan reseptor
GLUT-1 dan aktivitas hexokinase)
GLUT-1 berfungsi menghantarkan glukosa
masuk ke sel tumor
Hexokinase berfungsi mempertahankan glukosa
di dalam sel

Herring W.. Learning Radiology Recognizing The Basics 3 rd Edition. Elsevier. 2016
Zhu A., Lee D., Shim H.. Metabolic PET Imaging in Cancer Detection and Therapy Response.
Semin Oncol. 2011

18F-fluorodeoxyglucose

(FDG)

Half life 109 menit

Konsentrasi mencapai plateau dalam
45-60 menit imaging dapat
dimulai
FDG tidak direabsorpsi oleh ginjal

Herring W.. Learning Radiology Recognizing The Basics 3 rd Edition. Elsevier. 2016
Moghbel M, Newberg A, Alavi A. Positron emission tomography: ligand imaging. Philadelphia:
Elsevier; 2016.

18F-fluorodeoxyglucose

(FDG)

Dosis dewasa = 185-740 MBq (5-20 mCi)

Dosis anak = 5.2 MBq/kg (0.10-.0.14 mCi/kg)
Uptake fisiologis FDG beberapa organ : salivary gland,
tiroid, brown fat, timus, liver, GIT, ginjal, VU dan uterus

Herring W.. Learning Radiology Recognizing The Basics 3 rd Edition. Elsevier. 2016
Moghbel M, Newberg A, Alavi A. Positron emission tomography: ligand imaging.
Philadelphia: Elsevier; 2016.

Aplikasi Klinis

Dementia
Diagnosis dini Penatalaksanaan awal
Tidak ada gambaran klasik awal demensia
PET dapat memberikan pencitraan awal

Alzheimers Disease (1)

Pola penurunan metabolisme glukosa regional simetris pada korteks
temporoparietal posterior bilateral, lobus temporal anterior dan
media
Korteks sensorimotor dan substantia grisea subkorteks dan
cerebellum tidak terganggu (spared)
Pola hipometabolik dapat juga asimetri dengan jumlah signifikan
PET + CT / MRI identifikasi area atrofi dari bagian hipometabolik

 (A) 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)

images from a patient with Alzheimers disease. Arrows indicate
regions of diminished metabolism in the bilateral parietal and
temporal lobes, with sparing of the sensorimotor strip.
(B) FDG PET images from a patient with Alzheimers disease. Imaging
findings are often asymmetric, as demonstrated in this case. Arrows
indicate regions of diminished metabolism in the left parietal and
temporal lobes, with sparing of the sensorimotor strip.

Alzheimers Disease (2)

Adanya korelasi antara derajat hipometabolisme asimetri regional dan
defisit kognitif dan perilaku terobservasi secara klinis.
PET + biomarker prediksi faktor prognostik
APOE homozygous alel APOE-4 + gambaran defisit hipometabolik lobus
temporal dan parietal posterior bilateral lebih secara signifikan
berkembang AD dibandingkan dengan individu APOE-4 + dan PET

Dementia Frontotemporal
Perubahan mood dan perilaku obsesif dan kesulitan berbahasa
kehilangan inhibisi dan ekshibisi perilaku antisosial
Hipometabolik predominan pada lobus frontal dan temporal anterior.
Metabolisme glukosa asimetri dapat terlihat.
FTD gyrus cingulatus posterior lebih menetap
AD hipometabolik

18F-Fluorodeoxyglucose

positron emission tomography images from a

patient with frontotemporal dementia. Arrows indicate regions of
diminished metabolism in the bilateral frontal and temporal lobes.

Dementia Lewy-Body Difusa (1)

Adanya badan Lewy (-synuclein cytoplasmic inclusions) pada otak
Trias : parkinsonisme, halusinasi visual, dan penurunan kognitif
Hipometabolik regio parietal lebih dalam (dibandingkan AD) dan
meluas ke korteks occipital, khususnya ada keterlibatan korteks visual
primer.
Gyrus cingulatus tidak terganggu (spared) cingulate island sign
Sangat sugestif kombinasi halusinasi visual dan keterlibatan korteks visual
primer

Lobus temporal anterior tidak terganggu

18F-Fluorodeoxyglucose

positron emission tomography images from a

patient with diffuse Lewy body disease. Arrows indicate regions of
diminished metabolism in the bilateral parietal and occipital lobes.

Dementia Lewy-Body Difusa (2)

Radiofarmaka ini dapat menilai integritas neuron dopaminergik
membedakan DLBD dengan AD

Presynaptic dopamine imaging : 18F-fluorodopa (FDOPA) menilai kapasitas

sintesis dopamin (DLBD abnormal)
Dopamine transporter imaging : 11C-methylphenidate dan 11C-PE2I
Vesicular monoamine transporter imaging : 11C-DTBZ dan 18F-FP-DTBZ
SPECT dopamine transporter : 123I-FP-CIT (DaTscan)

FDG membedakan bentuk dementia lain : Creutzfeldt Jakob

disease, degenerasi corticobasal, dan dementia ischemic vascular.

Pencitraan Amyloid (1)

Radiofarmaka PET -amyloid-avid deteksi -amyloid secara cepat
menembus sawar darah otak, afinitas ikat tinggi dengan protein amyloid, dan dapat menghitung jumlah protein amyloid in vivo.
Lainnya :
2-(4-methylamino) phenyl-6-hydroxy-benzothiazole (11Clabeled BTA) (a.k.a.
Pittsburgh compound B / PIB)
1-(1-[6[(2-fluoroethyl)(methyl)(amino)]-2-naphthyl]-ethylidene malonitrile
(FDDNP)
Florbetapir (18F-Amyvid 2012), 18 F-florbetaben, dan 18F-flutemetamol
berikatan untuk mengagregasi -amyloid fibril ekstraneuronal di otak (AD)

Pencitraan Amyloid (2)

-amyloid + pada PET bukan diagnosis AD
Akurasi pencitraan amyloid pada AD tergantung usia
Amyvid sedikit / tidak ada plaque neuritik dan inkonsisten
dengan neuropatologis AD mengurangi kecenderungan gangguan
kognitif yang dikarenakan AD
Amyvid + sedang / banyak plaque neuritik amyloid pada AD dan
usia lanjut dengan kognitif normal
Amyvid harus digabung dengan modalitas lain

Pencitraan Amyloid (3)

The Society of Nuclear Medicine and Molecular Imaging dan the
Alzheimers Association kriteria penggunaan pencitraan amyloid
sebagai radiofarmaka PET yang sesuai.
Indikasi :

Pasien dengan MCI yang persisten / progresif yang tidak jelas

Pasien dengan kriteria klinis inti yang memuaskan untuk kemungkinan AD
karena presentasi klinis yang tidak jelas (clinical course atipikal / etiologi
campuran)
Pasien dengan dementia progresif dan onset pada usia lebih awal atipikal (<
65 tahun)

Pencitraan Amyloid (4)

Kontraindikasi :

Pasien dengan kriteria klinis inti yang memungkinkan AD dengan onset usia
tipikal
Untuk menilai keparahan dementia
Didasarkan pada riwayat keluarga + dementia / adanya APOE-4
Pasien dengan gangguan kognitif yang tidak terkonfirmasi pada PF
Sebagai pengganti genotipe untuk carrier mutasi autosomal yang disuspek
Pada individu asimptomatik
Keperluan non-medis (skrining, asuransi)

Transaxial parametric images through a midthalamic level of an Alzheimers patient (left)

and a healthy subject (right) show voxel-wise binding potential (BPND) that is proportional
to -amyloid binding-site density, generated from 90 minutes dynamic positron emission
tomography data acquired after an injection of 18F-florbetaben. -amyloid binding is seen
in the frontotemporal cortices of the Alzheimers patients brain (arrows), with only mild
nonspecific binding in the white matter and subcortical gray matter of the healthy
subjects brain (right). No cortical -amyloid binding is seen in the healthy subjects brain.

Epilepsi (1)
FDG PET evaluasi presurgical pada pasien epilepsi dengan kejang
partial refrakter.
FDG PET +

MRI, tes neurofisiologis, monitoring video noninvasif / EEG, dan perfusi ictal
dan interictal SPECT dengan 99m Tc-HMPAO / 99m Tc-ECD

PET interictal mendeteksi daerah penurunan metabolisme glukosa

pada zona epileptogenik
FDG diambil oleh otak lebih dari 1 periode sekitar 40 menit setelah
injeksi.
FDG PET tidak berguna melokalisasi zona epileptogenik

Epilepsi (2)
SPECT ictal semakin luas dan intense fokus hipoperfusi ictal
zona onset ictal
FDG PET penurunan metabolisme glukosa zona epileptogenik
Kekurangan SPECT ictal resolusi temporal yang buruk karena
lamanya waktu yan diperlukan radiofarmaka mencapai otak dan
terperangkap di sana setelah IV.
SPECT ictal gambaran hipoperfusi pada zona onset ictal dan jalur
propagasi kejang dan fokus perfusi lebih intense pada propagasi
kejang

Epilepsi (3)
FDG PET daerah hipometabolik pada interictal sering melebihi
ukuran regio anatomis pada onset kejang.
Semakin sering riwayat kejang berulang, daerah hipometabolik meluas.

Kombinasi SPECT ictal dan FDG PET interictal meningkatkan akurasi

lokalisasi
Definisi zona onset epileptogenic (SPECT ictal)
Zona inhibisi sekitar (SPECT ictal)
Defisit fungsional pada epilepsy partial refrakter (PET)

Epilepsi (4)
Kombinasi PET dan SPECT berpotensi menyelidiki proses patofisiologi lain
epilepsi yang berhubungan dengan perubahan perfusi cerebral dan
metabolisme glukosa
Reseptor serotonin 1A (5-HT1A) dan -aminobutyric acid (GABA) tereduksi di
lobus temporal individu epilepsy dengan radiofarmaka PET
18F-trans-4-fluoro-N-2[4- (2-methoxyphenyl)piperazin-1-yl]ethyl]-N-(2-pyridyl)cyclohexanecarboxamide (18F-FCWAY) spesifik ikat reseptor 5-HT1A sentral
11C-flumazenil spesifik ikat rseptor GABA
-11C-methyl-L-tryptophan (AMT) deteksi focus kejang pada pasien dengan
epileptogenic tubers
AMT melacak metabolisme triptofan melalui jalur serotonin &/ kynurenine
tepat fokus epileptogenic pada fase interictal ditandai peningkatan uptake AMT

18F-Fluorodeoxyglucose

positron emission tomography images from a 12-year-old girl

with medically refractory epilepsy. Transaxial (left) and coronal (right) planes are shown.
These images were acquired in the interictal state, and demonstrate decreased
metabolism in the mesial left temporal lobe, as indicated by the arrows. This finding is
consistent with an epileptogenic focus in the mesial left temporal lobe.

Gangguan Gerak (1)

Parkinsons disease (PD), progressive supranuclear palsy (PSP), dan
multiple system atrophy (MSA)
Radiofarmaka PET : komponen pada system dopamine presinaps (D1)
atau postsinaps (D2)

18F-FDOPA

IV dikonversi dengan asam amino aromatik dekarbosilase

(AADC) 18F-fluorodopamine terperangkap di antara neuron dopamine
presinaps. (FDOPA refleksi aktivitas AADC marker sintesis dopamine)

Gangguan Gerak (2)

Penurunan uptake 18F-FDOPA pada striatum 2 karakteristik regional
pada PD
Uptake radiofarmaka pada striatum kontralateral hingga ke bagian terganggu
lebih dari dibandingkan sisi ipsilateral.
Uptake radiofarmaka lebih berkurang pada putamen dibandingkan caudatus.

Konsisten dengan degenerasi neuron nigrostriatal asimetri.

Sunstantia nigra ventrolateral proyeksi putamen berdegenerasi lebih
berat dibandingkan proyeksi caudatus.

Gangguan Gerak (3)

Neuron dopamine berdegenerasi pada MSA dan PSP (kurang asimetri
pada PD)
PET mengevaluasi reseptor dopamine D2 postsinaps ikatan
reseptor dopamine D2 striatal intak pada PD (berkurang pada MSA
dan PSP, Huntingtons disease)
Reseptor D2 akan meningkat pada PD tidak ditatalaksana
digunakan untuk prediksi respon terapi dopamine agonis (scan
postsinaps)

Gangguan Gerak (4)

18F-FDG PET, 11C-raclopride (RACLO) PET, dan MRI

Penurunan uptake radiofarmaka striatal dengan FDG dan RACLO PET MSA
Peningkatan signal pada putamen dan pons dengan MRI T2 atau diffusion
weighted PSP

18F-DOPA PET menentukan stadium degenerasi dopaminergik pada

PD
Penurunan fungsi dopaminergic mulai dari dorsal caudal putamen
kontralateral hingga bagian terganggu
Rate degenerasi pada nucleus caudatus lebih lambat dibandingkan putamen
(PD awal)

Gangguan Gerak (5)

11C-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile
(11C-DASB) radiofarmaka PET yang berikatan dengan presinaps
terminal ekspresikan transporter serotonin (SERT) ukur integritas
inervasi serotonergik
Berkurangnya ikatan 11C-DASB pada striatal, batang otak, dan korteks
disfungsi serotonergik progresif nonlinear pada PD

Parametric images of brain serotonin

transporter BPND modeled from 120
minutes dynamically acquired
positron emission tomography (PET)
data after an injection of 11C-3amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile (11CDASB) in a healthy subject. Transaxial
images at a midthalamic level (left)
and mid-sagittal images (right) with
PET only (top) and PET co-registered
on to a magnetic resonance imaging
scan (bottom) show high serotonin
transporter densities in the posterior
thalamus (solid arrow) and the raphe
complex in the brainstem (hollow
arrow) as well as moderate serotonin
transporter binding in the striatum
(asterisks) and mild binding in the
limbic cortex (arrow head).

Infeksi dan Inflamasi (1)

Pada pasien HIV positif: SOL pada MRI : ?
PET dengan FDG: highly metabolically active lymphomas demonstrate
markedly increased FDG uptake.
Nonneoplastic lesions: toxoplasmosis, syphilis gummas:
hypometabolic
Although some infectious foci may be hypermetabolic and some
lymphoma lesions may only be mildly hypermetabolic

18F-Fluorodeoxyglucose

(FDG) positron emission tomography (PET) images from a 61year-old woman with central nervous system lymphoma; transaxial PET and computed
tomography (CT) images (left and middle) and a coronal PET image (right) are shown. The
arrows indicate a markedly FDG-avid mass (standardized uptake value = 21) in the left
temporal lobe which demonstrates increased density on CT images, with surrounding
hypodensity/decreased FDG activity consistent with vasogenic edema.

Transaxial 18F-fluorodeoxyglucose (FDG) positron emission tomography (left) and

contrast-enhanced magnetic resonance imaging (right) images from a 62-year-old woman
with human immunodeficiency virus and central nervous system toxoplasmosis. The
arrows indicate an irregularly enhancing lesion near the left caudate head, which
demonstrates very low FDG activity more suggestive of an infectious etiology rather than
lymphoma. The diagnosis of toxoplasmosis was confirmed after the lesion responded to
treatment.

Transaxial (left) and coronal (right) 18Ffluorodeoxyglucose (FDG) positron emission

tomography images in a 69-year-old woman with voltage-gated potassium channel
antibody limbic encephalitis, syndrome of inappropriate antidiuretic hormone
secretion (SIADH), sympathetic instability, and postural hypotension without clear
underlying primary neoplasm. The arrows indicate a focus of increased FDG activity
(standardized uptake value = 18.6) in the left amygdala consistent with active
limbic encephalitis.

Infeksi dan Inflamasi (2)

Abses bacterial atau empyema subdural menunjukkan derajat
metabolism glukosa yang bervariasi: some demonstrating photopenia
while others demonstrating increased metabolism, particularly at the
periphery.
mechanism of increased FDG uptake in abscesses: increased glucose
metabolism associated with the inflammatory process and increased
cellularity rather than disruption of the bloodbrain barrier

Infeksi dan Inflamasi (3)

PET dengan FDG dan 11C-methionine : increased radiotracer uptake at
the periphery of the lesions 11C-methionine demonstrated a
greater abscess-to-background ratio compared to FDG.
Hypermetabolism on PET reflects different aspects or stages of
inflammation that are not visible on contrast-enhanced MRI
PET demonstrated bilateral hypermetabolism that extended beyond
the abnormal lesions detected by contrast-enhanced MRI
Hipermetabolisme fokal mungkin merepresentasikan aktivitas kejang
Hipermetabolisme merefleksikan proses inflamasi yang mendasari

Transaxial 18F-fluorodeoxyglucose (FDG) positron emission tomography (left) and

contrast-enhanced magnetic resonance imaging (right) images from a 34-year-old
woman with acute disseminated encephalomyelitis (ADEM). The arrows indicate
enhancing lesions in the posterior periventricular white matter and right parietal
white matter which demonstrate increased FDG activity (standardized uptake value
(SUV) = 6.3) relative to adjacent normal white matter (SUV = 2.7).

Penyakit Serebrovaskular
Stroke akut : CT, MRI, dan functional MRI > SPECT dan PET
PET menilai: oxygen extraction fraction in patients being considered
for corrective surgery for carotid artery obstructive disease.
The current standard of reference for measuring cerebral blood flow:
PET imaging with 15O-labeled water, H215O
Hypoxia nitroimidazole-based radiopharmaceuticals: 18 Ffluoromisonidazole (FMISO) and 18F-fluoroazomycinarabinoside
(FAZA).

Tumor Otak (1)

Primer atau metastasis
Primer: glioma (90% pada dewasa, 60% dari seluruh tumor otak).
FDG PET: pencitraan berdasarkan glycolic activity of the tumor
tumor tingkat lebih tinggi menunjukkan metabolism lebih tinggi
Agen yang diakui FDA dalam pencitraan tumor FDG :
defining extent of tumor and grade of malignancy
assessment of treatment response
evaluation of radiation necrosis versus tumor recurrence

Transaxial 18F-fluorodeoxyglucose (FDG) (left) and contrast-enhanced magnetic

resonance imaging (MRI) (right) images from a patient 6 months after resection of
a glioblastoma multiforme (GBM) in the medial left frontal lobe. Ring enhancement
on contrast-enhanced MRI images (arrow) raised concern for tumor recurrence,
but lack of associated FDG activity on positron emission tomography images was
consistent with radiation necrosis.

A 43-year-old man 3 years after surgical resection/chemotherapy/radiation therapy for

an anaplastic oligodendroglioma in the left medial temporal/thalamic region. Initial
transaxial 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) images
demonstrate no abnormal FDG activity (left). Seven months later a follow-up FDG PET
study (middle) reveals a new focus of FDG activity (standardized uptake value = 12) just
posterior and lateral to the left thalamus (arrow), which corresponds to a focus of
enhancement on contrast-enhanced magnetic resonance imaging (right).

Tumor Otak (2)

Although FDG has been useful in imaging high-grade gliomas (Fig.
11.18), it has been shown to be less accurate in the detection of
lower-grade tumors due to high background activity from normal
brain glucose metabolism. However, low-grade tumors often
demonstrate relatively decreased glucose metabolism when
compared to normal brain (Di Chiro et al., 1982), and can be seen as
photopenic defects superimposed on a background of normal glucose
activity (Fig. 11.19).

Transaxial 18F-fluorodeoxyglucose (FDG)

positron emission tomography (PET)
(upper left) and contrast-enhanced
magnetic resonance imaging (MRI) (upper
right) images from a 69-year-old man
with a right frontal glioblastoma
multiforme (GBM); the images
demonstrate an FDG-avid mass
(standardized uptake value (SUV) = 9.3)
with central necrosis and heterogeneous
enhancement, consistent with a highgrade neoplasm. Transaxial FDG PET and
contrast-enhanced MRI images (lower left
and right, respectively) from a 55-year-old
man with a left parietal GBM; the images
demonstrate an FDG-avid multicystic
mass (SUV = 10) with central necrosis and
peripheral enhancement, consistent with
a high-grade neoplasm.

Transaxial 18F-fluorodeoxyglucose positron emission tomography (left)

and contrast-enhanced magnetic resonance imaging (right) images from
a 19-year-old man with a right parietal dysembryoplastic neuroepithelial
tumor (DNET). The images demonstrate a nonenhancing cystic and solid
hypometabolic mass, consistent with a low-grade neoplasm.

Simpulan

Simpulan
PET aplikasi klinis dan penilitian neuroimaging
2 radiofarmaka : FDG dan Amyvid
Perkembangannya radiofarmaka berperan secara integral pada bagian
neurologi dan bedah saraf

Referensi

Referensi
1. Lameka K, Farwell MD, Ichise M. Positron Emission Tomography. Handb
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2. Hacker M. PET & SPECT Oncology. Available from:
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